Central, peripheral ECMO or CPB? Comparsion between circulatory support methods used during lung transplantation

Area of Science:

• Cardiovascular and Thoracic Surgery
• Transplantation Medicine
• Respiratory Medicine

Background:

• Lung transplantation (LuTx) is crucial for end-stage lung diseases like COPD, cystic fibrosis, and interstitial pneumonia.
• Accurate assessment of gas exchange reserve is vital due to irreversible lung damage and respiratory insufficiency.
• Extracorporeal life support, including cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO), may be necessary during LuTx but carries risks like acute kidney injury and bleeding.

Purpose of the Study:

• To evaluate the impact of intraoperative extracorporeal support on survival and postoperative complications in lung transplantation.
• To compare the outcomes of central ECMO, peripheral ECMO, and CPB versus no external support during LuTx.

Main Methods:

• A retrospective review of 77 lung transplantations performed between 2009 and 2020.
• Analysis of 40 patients requiring intraoperative extracorporeal assistance (8 CPB, 32 ECMO).
• Comparison of survival rates and postoperative complications using Kaplan-Meier curves and Chi-square/t-test analyses.

Main Results:

• Central ECMO use was associated with improved survival rates compared to no support (5-year survival: 66% vs. 44%).
• Survival was also enhanced with central ECMO compared to peripheral ECMO (5-year survival: 66% vs. 33%) and CPB (5-year survival: 66% vs. 38%).
• Acute kidney injury and thromboembolic complications were significantly more frequent in patients receiving extracorporeal support (p<0.05).

Conclusions:

• Central ECMO is favored over peripheral cannulation and CPB for lung transplantation.
• Cardiopulmonary bypass (CPB) should be discontinued for lung transplant procedures.
• While extracorporeal support aids survival, careful monitoring for complications like AKI and thromboembolism is essential.